Healthcare Provider Details

I. General information

NPI: 1760205330
Provider Name (Legal Business Name): AMANDA NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S STATE ROAD 7 STE 200
WELLINGTON FL
33414-6204
US

IV. Provider business mailing address

1381 BLUE CLOVER LN
WEST PALM BEACH FL
33415-4408
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: